Guidance on the use of biological agents in the treatment of oral mucosal disease

O’Neill, Iain D.

doi:10.1111/j.1365-2133.2010.09704.x

Cited by 6 publications

(18 citation statements)

References 8 publications

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“…It must be recognised therefore that, currently, the collective experience of the use of biological agents in the practice of oral medicine is limited. The safety aspects and need for adequate supervision of response and potential adverse effects associated with biologics would suggest that systemic use in oral medicine should be in conjunction with clinicians experienced in the use of these agents including medical specialists with appropriate assessment, registry entry, monitoring and support (O’Neill, 2010).…”

Section: Discussion and The Futurementioning

confidence: 99%

Biologics in oral medicine: ulcerative disorders

O’Neill¹,

Scully²

2012

Oral Diseases

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Inflammatory ulcerative diseases of the oral mucosa are wide ranging but include especially aphthous and aphthous-like ulceration, vesiculobullous disorders and erosive lichen planus (LP). While most patients with these conditions respond to conventional topical and/or systemic immunosuppressive agents, treatment-resistant cases remain challenging. In these, the use of biologics such as tumour necrosis factor alpha (TNF-α) inhibitors or rituximab may be of benefit. This article reviews the use of biologics in ulcerative oral conditions, highlighting potential benefits, adverse effects and principles of use and future developments. TNF-α inhibitors such as infliximab can be effective in inducing resolution in oral aphthous and aphthous-like ulcers and may be an appropriate therapy in those patients in which disease is severe and refractory to, or patients are intolerant of, traditional immunomodulatory regimens. There would also seem support and rationale for use of biologics (mainly rituximab) in pemphigus but not in oral LP or other oral ulcerative conditions.

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Section: Discussion and The Futurementioning

confidence: 99%

Biologics in oral medicine: ulcerative disorders

O’Neill¹,

Scully²

2012

Oral Diseases

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“…The significant limitation of these data is that they comprise only case reports, and as such may also be open to some degree of publication bias. Consequently, the evidence base to support the use of TNF‐α antagonists in oral aphthous ulceration remains weak 15,16 . Although it is common in such instances to welcome further controlled studies to better define such a role, and to provide a genuine evidence‐basis for use, at present no such studies in aphthous ulceration are available (with the exception of that of Melikoglu et al.…”

Section: Discussionmentioning

confidence: 99%

“…Following the development of TNF‐α antagonists (e.g. infliximab, etanercept and adalimumab) and use in a variety of inflammatory dermatological, rheumatological and gastroenterological conditions, their use in successfully treating severe aphthous ulceration in patients resistant to or intolerant of systemic therapy (including thalidomide) has been increasingly reported 15,16 . However, the evidence base for such use remains weak.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of tumour necrosis factor‐α antagonists in aphthous ulceration: review of published individual patient data

O’Neill¹

2011

Acad Dermatol Venereol

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Evidence for efficacy of TNF-α antagonists in aphthous ulceration infection is limited. Such data suggest that in patients with severe aphthous ulceration TNF-α antagonists have some efficacy in inducing ulcer resolution and reducing recurrence. These agents may represent an option in severe refractory aphthosis, although in the absence of controlled studies, caution is advocated if use is to be considered.

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“…It must be recognized therefore that, currently, the collective experience of the use of biologic agents in the practice of oral medicine is limited. The safety aspects and need for adequate supervision of response and potential adverse effects associated with biologics would suggest that systemic use in oral medicine should be in conjunction with those clinicians experienced in the use of these agents including medical specialists with appropriate assessment, registry entry, facilities, monitoring and support (O’Neill, 2010). Cost considerations are also relevant.…”

Section: Practical Aspects For Use and Monitoring Of Biologic Therapiesmentioning

confidence: 99%

“…The success of the biologic agents in these conditions has led to their off‐label use in a wide variety of mucocutaneous diseases; however, the evidence of efficacy in these states is less powerful (or indeed sometimes absent), and no formal recommendations for such use are yet available (Graves et al , 2007). Such off‐label use is also increasingly reported for the treatment of severe oral mucosal diseases (O’Neill, 2008, 2010; Zhang et al , 2011), but the data supporting such use are still limited. As we discuss in following articles in this series, this includes particularly the use of TNF‐α blockers in aphthous ulceration, oral CD and orofacial granulomatosis (OFG), and of rituximab in pemphigus vulgaris and in Sjogren syndrome (SS).…”

mentioning

confidence: 99%

Biologics in oral medicine: principles of use and practical considerations

O’Neill¹,

Scully²

2012

Oral Diseases

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Oral Diseases (2012) 18, 525–536 Biologic therapies are relatively innovative treatments aimed at modulating lymphocytes or cytokines. There are currently three broad classes of biologic therapies, tumour necrosis factor‐alpha inhibitors, lymphocyte modulators and interleukin inhibitors; all are increasingly used in the treatment of inflammatory immune‐mediated conditions, and several have potential applications in oral medicine. Guidelines for their use in licensed indications (e.g. rheumatoid arthritis, psoriasis, inflammatory bowel disease) include recommendations and guidance for patient selection and subsequent monitoring with discussion of potential adverse effects. An understanding of these is important when managing patients receiving biologic therapy for systemic disease, and compliance is essential in any use in oral medicine. Key aspects of current guidance are presented with particular emphasis on their relevance to clinicians working within oral and maxillofacial medicine/pathology/surgery and in specialist practice.

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Guidance on the use of biological agents in the treatment of oral mucosal disease

Cited by 6 publications

References 8 publications

Biologics in oral medicine: ulcerative disorders

Biologics in oral medicine: ulcerative disorders

Efficacy of tumour necrosis factor‐α antagonists in aphthous ulceration: review of published individual patient data

Biologics in oral medicine: principles of use and practical considerations

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